Significance and alteration of T help 17 cells in immune globulin-resistant gawasaki disease / 中华风湿病学杂志

ABSTRACT

Objective To investigate the alteration and significance of T help 17 cells (Th17), in patients with intravenous immune globulin-resistant Kawasaki disease (KD). Methods Forty-five children with KD (thirty-five as sensitive group and ten as the resistant group) and thirty age-matched healthy children were studied. Real-time PCR was used to evaluate the mRNA levels of IL-17A/F, ROR-γt. The proportion of Th17 in peripheral blood was detected by flow cytometric analysis. Th17-related plasma cytokine (including IL-17A and IL-6) concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results ① Compared with healthy eontrols, transcription levels of IL-17A/F were significantly upregulated during acute phase of KD (P<0.01). ② Compared with sensitive group, the transcription levels of IL-17A/F, ROR-γt were significantly up-regulated during acute phase in immune globulin-resistant KD (P< 0.01), and down-regulated after treatment with intravenous immunoglobulin (IVIG) therapy in sensitive group (P<0.01), but there was no significant difference in the levels of expression in resistant group (P>0.05). There was significant difference in serum IL-17A,IL-6 before or after IVIG between resistant and nonresistant group (P<0.01). ③ Compared with the normal controls, serum IL-17A, IL-6 were markedly elevated in patients with KD. There was significant difference in serum IL-17A and IL-6 concentrations between resistant and sensitive group before IVIG treatment (P<0.01). The resistant group showed ignificantly high IL-17A, IL-6 after IVIG. There was no significant difference in the severity of decrease before and after IVIG in both groups, but it was found that serum IL-17A and IL-6 had a tendency to decrease after treatment with IVIG. ④ Methyiprednisolone might down-regulate inflammatory response through inhibiting the secretion of inflammatory IL-6 and IL-17A cytokines in acute stage of immunoglobulin-resistant KD. Treatment of immunoglobulin-resistant Kawasaki disease with IVMP resulted in faster resolution of fever, more rapid improvement in markers of inflammation. Conclusion Aberrant activation of Th17 cells may be one of the factors causing disturbed immunological function in immunoglobulin-resistant KD.